History of renal physiology in Germany during the 19th century.

The roots of renal physiology in Germany in the last century have been traced. Vitalistic concepts became replaced by physical, chemical and mechanistic laws which govern biological processes. First, the main exponents of renal physiology, J. Henle, C. Ludwig and R.P.H. Heidenhain, are discussed, then the (indirect) contributions of A. Fick, K. Peter, H. Helmholtz, E. du Bois-Reymond, J.L. Schönlein and A. Dohrn are evaluated. The original literature bearing on renal physiology in the 19th century is screened by a survey of publications in Pflügers Archiv and Archiv der experimentellen Pathologie und Pharmakologie. We point to the international cooperation in the field. At the turn of the century, renal function was adequately described by a theory of glomerular filtration, tubular secretion and tubular reabsorption.

Myxedema.

This review will discuss generalized myxedema as it develops in hypothyroidism. First, the precipitating conditions (thyroprivic trophoprivic + goitrous forms) and the clinical manifestations of thyroid hormone deficiency are presented. Pathobiochemical and pathophysiological factors that lead to the main manifestations include retention of fluid, retention of sodium and hyponatremia. In particular are primary and direct consequences of reduced thyroid hormone levels, and secondary or indirect consequences, such as cardiovascular and renal derangements. In hypothyroidism many biochemical disturbances result. Most important is the interstitial deposition of hydrophilic mucopolysaccharides, which in turn lead to fluid and Na retention and impairment of blood circulation and lymphatic drainage. Myxedema, therefore, is to a large extent a lymphatic edema. Hyponatremia is an indirect consequence of the lack of T3 and is directly caused by impaired renal Na reabsorption. Renal Na,K-ATPase is reduced in specific segments. The often discussed role of inappropriate elevation of circulating ADH does not seem to be a key factor in myxedema. Impaired capacity of renal water excretion is caused by reduced GFR. We discuss the time dependent development of the derangement of different organ systems, and include recently published biochemical results, according to which the lack of T3 interferes not only with the metabolism of numerous compounds of the interstitial matrix, but also with cell surface proteins and intracellular proteins of microfilaments. Finally, we refer briefly to pretibial myxedema in states of hyperthyroidism, that is, infiltrative dermopathy in Graves' disease, which is caused by poorly understood autoimmune processes.

In vitro 6 beta-hydroxylation of progesterone in human renal tissue.

Increased levels of 6 beta-hydroxylated steroids have been found in the urine of several species under different physiological and pathophysiological conditions. Until now, liver, adrenal glands and placenta have been identified as organs which contain 6 beta-hydroxylase activity. However, it has not yet been established whether 6 beta-hydroxylation occurs in mammalian kidney. In this study we have performed in vitro studies with preparations from rat and human kidney cortex and have obtained evidence for the presence of a small but significant renal 6 beta-hydroxylation activity. Two points deserve to be mentioned: 1) A species difference is documented by the presence of the enzyme in human, but not in rat kidney; 2) Substrate specificity is evident. Progesterone, but not corticosterone, was transformed to the 6 beta-hydroxylated metabolite in human tissue. The biological significance of the 6 beta-hydroxylation of endogenous, as well as exogenous steroids could be that 6 beta-hydroxylation opens an alternate route of progesterone metabolism in parallel to other conversion and/or degradation pathways. Furthermore, since other 6 beta-hydroxylated steroids have been reported to exert biological effects, this may also be the case with 6 beta-hydroxy progesterone.

Renal imaging techniques.

The ancient approach to obtain an image of the kidneys (and other internal organs) was 'section-inspection-imaging' by drawing, painting, sculpturing, and modelling. The present study follows chronologically the development and use of sectioning techniques from ancient (often forbidden) methods to modern microdissection and maceration of silicone-rubber-injected tubules. Inspection evolved from the use of the naked eye to magnifying lenses, microscopes and finally electron microscopy. Pertinent examples such as the description of the kidneys as the site of urine formation, the visualization of loop structures in the renal medulla and the imaging of tight junction strands are discussed. Inspection or visualization of renal structure and function has been revolutionized by modern noninvasive techniques, such as X-ray imaging, imaging by radioisotopes, ultrasound, computer tomography and nuclear magnetic resonance. Pertinent examples are given demonstrating the potency of the various techniques. The contribution of computerized data evaluation is discussed. The development of micropuncture and microperfusion techniques has opened the field for direct imaging not only of renal (sub)structural details but also of functional parameters such as transtubular reabsorption rates, single glomerular capillary filtration and conductance of the paracellular pathway. We focus particularly on techniques specifically designed to visualize renal hemodynamic and transport parameters.

Interaction of 11 beta-hydroxysteroid-oxido reductase in different organs of various mammalian species.

Distribution of 11 beta-HSOR activity in different organs has been measured using tissue slices, homogenates, and microsomes. The biological material was incubated in vitro with cortisol/ cortisone (human preparations) or corticosterone/11-dehydrocorticosterone, respectively (animal preparations). Metabolites formed were quantified using RP-HPLC and on-line detection of labeled compounds. The typical pattern of CS-metabolism as obtained with rat tissue slices revealed that testis, rectum and kidney are predominant oxidizers of active gluco-CS, while liver and lung mainly function as reducers. Human placenta preparations display an exclusive oxidase activity. To trace different types of 11 beta-HSOR homogenates and microsomes of various organs were incubated with different cosubstrates (NAD+/NADH or NADP+/ NADPH, respectively). In accordance with previous reports, this study found that isoenzymes with different cosubstrate preferences exist in individual organs. 11 beta-HS oxidase activity displays a NAD+ preference in the human placenta. There was no apparent difference in cosubstrate preference between human and guinea pig placenta homogenates. In mice there is also a detectable reductive activity, whereas the Sprague-Dawley rat and golden hamster do not show any detectable activities.

Does corticosteroid metabolism in target organs affect the cardiovascular system?

The target organ metabolism of corticosteroids has been measured with biochemical and immunohistochemical techniques. Attention was focused on the key enzyme system 11 beta-hydroxysteroid oxidoreductase (11 beta-HSOR, EC 1.1.1.146). Several organs of rats, including kidney, colon, testis, pancreas, liver, lung and heart, express oxidative, as well as reductive activity, albeit with different ratios. The specific co-substrate preference in different organs points to the presence of isoforms of the enzyme, which can be inhibited by steroid compounds. In kidney tubules longitudinal heterogeneity of the enzyme distribution pattern has been reported. Inhibition of 11 beta-HSOR in transporting epithelia such as those of kidney and colon by liquorice, glycyrrhetinic acid and others leads to aldosterone-like effects of glucocorticosteroids. The mechanism of this effect is breakdown of the specific 11 beta-HSOR barrier for glucocorticosteroids which subsequently bind to mineralocorticosteroid receptors. Other possible mechanisms of interaction of the corticosteroid metabolism and the cardiovascular system are discussed.

Endogenous inhibitors of 11 beta-OHSD: existence and possible significance.

Inhibition of 11 beta-hydroxysteroid dehydrogenase (11 beta-OHSD) by licorice-derived compounds and in cases of idiopathic impairment of this enzyme is known to result in hypermineralocorticoid syndromes, reflecting corticosteroid receptor activation by excess intracellular glucocorticoids. In this paper we address the question of whether or not endogenous inhibitors of 11 beta-OHSD exist that might cause pathological glucocorticoid metabolism. Using microsomal preparations we have demonstrated that bile acids are potent inhibitors of rat renal and human hepatic 11 beta-OHSD, with lithocholic acid exerting the strongest effect. The human renal enzyme is affected to a lesser extent. Serum of patients with cholestatic liver cirrhosis also inhibited 11 beta-OHSD activity, in parallel with total bile acid concentration. Cholesterol and its precursor lanosterol inhibited the enzymatic activity in microsomes from rat and human kidney cortex and human liver. We conclude that bile acids could contribute to the abnormalities of cortisol metabolism observed in cholestatic liver cirrhosis.

Carl Ludwig, Jacob Henle, Hermann Helmholtz, Emil DuBois-Reymond and the scientific development of nephrology in Germany.

Medical science in the 2nd half of the 19th century proceeded in a stepwise fashion, when the development of new techniques permitted the evaluation of living processes by direct microscopic or endoscopic inspection, as well as by quantitative measurements of the underlying physical and chemical forces. Ludwig, Henle, Helmholtz and DuBois-Reymond all contributed in different ways to the evolution of medicine and physiology into natural sciences, freed from romantic, philosophic speculation. Nephrology benefitted from this development and from the contributions of the non-nephrologists to natural science.

Johann Lukas Schönlein and his contribution to nephrology and medicine.

Schönlein published few papers, and most of what is known of his achievements in nephrology comes from notes and publications of his students. It seems, however, that he described the combination of rheumatic fever, affection of internal muscular organs, a typical exanthem and oliguria, coining the name purpura rubra to describe this syndrome. Although patients with symptoms of Schönlein's syndrome had been described earlier, Schönlein was the first to describe purpura rheumatica as an entity. Schönlein's greatest contribution was the discovery of the anthropophilic pathogenic fungus Trichophyton schönleinii as the cause of the contagious skin condition favus (honeycomb ringworm). This opened a new field--mycology--and allowed therapy to be aimed specifically at the cause of the disease.

Metabolism of dexamethasone: sites and activity in mammalian tissues.

We have used in vitro techniques to study the metabolism of dexamethasone. Tissue slices, homogenates and microsomal fractions of various mammalian organs from rats and humans have been used. We focused particularly on the question of whether or not dexamethasone (Dexa) is oxidized at the C11-OH group by 11 beta-hydroxysteroid-dehydrogenase. High activities of this enzyme system for Dexa were localized in renal cortex and rectum. Material from both human and murine liver was ineffective. The main metabolite formed from Dexa in renal and intestinal systems was identified by different mass-spectrometric techniques including on line HPLC mass spectrometry as 11-dehydro-dexamethasone. This finding was corroborated by the observation that both corticosterone and glycyrrhetinic acid block the metabolic transformation of Dexa.

Corticosterone metabolism and membrane transport.

The mammalian kidney metabolizes virtually all of the steroid hormones. Corticosterone receptors have been found in the cortical collecting tubule, and at least four metabolites of the hormone have been identified in rat renal tissue and urine. The biologic activity of these metabolites is not completely known. In this study, we examined the functional effects of three of the metabolites of corticosterone on membrane transport in toad and turtle bladders; we also analyzed the oxidoreductase pathways for corticosterone metabolism. In the toad bladder, maximal water flow (vasopressin- and cyclic AMP-stimulated) was unaffected by corticosterone, 11-dehydro-20-dihydrocorticosterone (metabolite I) and 11-dehydrocorticosterone (metabolite IV); maximal water flow was significantly inhibited by 20-dihydrocorticosterone (metabolite II). Sodium transport in the toad bladder was stimulated by corticosterone, 11-dehydrocorticosterone and 20-dihydrocorticosterone. Analysis of the oxidoreductase pathways in this tissue revealed that most of the corticosterone was oxidized to 11-dehydrocorticosterone, a biologically active compound; 11-dehydrocorticosterone was further metabolized to 11-dehydro-20-dihydrocorticosterone, a biologically inactive compound. Only 6% of the parent compound was converted to 20-dihydrocorticosterone. In the turtle bladder, none of the metabolites tested altered hydrogen ion secretion over the time period studied; no significant biotransformation of corticosterone occurred in this tissue. As the metabolites of corticosterone found in toad bladder are the same as those identified in mammalian tissues, our studies suggest that some of them may be important modulators of sodium and water transport in the distal nephron. Our data further suggest that these compounds are likely not involved in the regulation of urinary acidification.

Inhibition of rat renal 11 beta-hydroxysteroid dehydrogenase by steroidal compounds and triterpenoids; structure/function relationship.

Various compounds with steroidal structure were tested for inhibitory effects on enzymatic activity of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD) from rat renal microsomes. Most substances exerting inhibitory potency on both the oxidative as well as the reductive activity can be classified into two main groups: pentacyclic triterpenoids of the oleane type and steroidal detergents of the CHAPS-series. Inhibition is competitive, as was shown for one compound of each group. The IC50 values of the various inhibitors range over five orders of magnitude. In all cases, oxidative activity was inhibited more effectively than reductive activity. An attempt has been made to correlate structural properties and inhibitory potency. In brief, inhibition seems to be enhanced by a C11-oxygen function, which is present in all endogenous glucocorticosteroids and a C7-OH function. Inhibition is reduced by a large and polar substituent at C3 in the A-ring. A large D-ring substituent, such as a bisgluconamidopropyl side chain or even an additional E-ring, does not prevent binding to the enzyme, although inhibition seems to be influenced by its steric conformation. The cardiac glycosides and steroidal antibiotics tested exert no inhibitory effect on 11 beta-HSD. Cholesterol and pentacyclic triterpenoids of the lupane type exhibit a very poor inhibition, probably caused by the localization of planar structures in the ring systems, which differs from that of the effective oleane type inhibitors.

Bile acids and their amidates inhibit 11 beta-hydroxysteroid dehydrogenase obtained from rat kidney.

Recently it has been demonstrated that interaction of corticosteroids with extraadrenal target cells can effectively be modulated by metabolic transformation of the steroid hormone. As far as 11-hydroxylated glucocorticoids are concerned 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD) is the most important enzyme charged with target cell metabolism. Inhibition of 11 beta-HSD function either by genetically transmitted deficiency or by exogenous enzyme inhibitors causes severe pathophysiological derangements, which result in a syndrome of "apparent mineralocorticoid excess". In the present paper we have tested whether or not endogenous inhibitors of this enzyme system might exist. The effects of the main naturally occurring mono-, di-, and trihydroxylated bile acids in man on 11 beta-HSD have been studied in in vitro experiments. Using rat renal microsomes it could be demonstrated that unconjugated bile acids of all three classes as well as the corresponding glycine and taurine amidates effectively inhibit oxidative as well as reductive activity of 11 beta-HSD, with lithocholic acid and chenodeoxycholic acid being the most potent compounds. It is concluded that bile acids are potent endogenous inhibitors of 11 beta-HSD and, therefore, could participate in abnormalities of cortisol metabolism observed in liver cirrhosis and extrahepatic biliary obstruction and, possibly, after ingestion of bile acids.

Contraluminal p-aminohippurate transport in the proximal tubule of the rat kidney. VIII. Transport of corticosteroids.

Using the stop-flow peritubular capillary microperfusion method contraluminal transport of corticosteroids was investigated (a) by determining the inhibitory potency (apparent Ki values) of these compounds against p-aminohippurate (PAH), dicarboxylate (succinate) and sulphate transport and (b) by measuring the transport rate of radiolabelled corticosteroids and its inhibition by probenecid. Progesterone did not inhibit contraluminal PAH influx but its 17 alpha- and 6 beta-hydroxy derivatives inhibited with an app. Ki of 0.36 mmol/l. Introduction of an OH group in position 21 of progesterone, to yield 11-deoxycorticosterone, augments the inhibitory potency considerably (app. Ki, PAH of 0.07 mmol/l). Acetylation of the OH-group in position 21 of 11-deoxycorticosterone, introduction of an additional hydroxy group in position 17 alpha to yield 11-deoxycortisol or in position 11 to yield corticosterone brings the app. Ki, PAH back again into the range of 0.2-0.4 mmol/l. Acetylation of corticosterone or introduction of a third OH group to yield cortisol does not change the inhibitory potency, but, omission of the 21-OH group or addition of an OH group in the 6 beta position reduces or abolishes it. Cortisol and its derivatives prednisolone, dexamethasone and cortisone exert similar inhibitory potencies (app. Ki, PAH 0.12-0.27 mmol/l). But again, omission of the 21-OH group in cortisone or addition of a 6 beta-OH group reduces or even abolishes the inhibitory potency against PAH transport. The interaction of corticosterone was not changed when 11 beta, 18-epoxy ring (aldosterone) was formed. On the other hand, the interaction was considerably augmented if the 11-hydroxy group was changed to an oxo group in 11-dehydrocorticosterone (app. Ki, PAH 0.02 mmol/l). When the A ring of corticosterone is saturated and reduced to 3 alpha, 11 beta-tetrahydrocorticosterone the inhibitory potency is not changed very much. But if more than four OH or oxo groups are on the pregnane skeleton or if the OH in position 21 is missing, the inhibitory potency decreases drastically (app. Ki, PAH 0.7-1.7 mmol/l). Introduction of a 21-ester sulphate into corticosterone, cortisol and cortisone does not change app. Ki, PAH very much. Glucuronidation, however, reduces it (app. Ki, PAH approximately 1.2 mmol/l). None of the tested corticosteroids interacts, in concentrations applicable, with dicarboxylate transport and only the sulphate esters interact with sulphate transport. Radiolabelled cortisol, D-aldosterone, 11-dehydrocorticosterone, and corticosterone are rapidly transported into proximal tubular cells. With the latter three compounds no sign of saturation and no transport inhibition with probenecid could be seen.(ABSTRACT TRUNCATED AT 400 WORDS)

Immunohistochemical localization of 11-hydroxysteroid dehydrogenase in rat kidney with monoclonal antibody.

Monoclonal antibody (MAb) against 11-hydroxysteroid dehydrogenase (11-HSD) has been raised by immunization of female balb/c mice. 11-HSD from solubilized rat renal microsomal protein could be bound in a modified ELISA using antimouse IgG and MAb against 11-HSD. On Western blots of solubilized rat renal microsomes the MAb recognized a single protein band of an approximate molecular weight of 35 kD. Immunohistochemical staining of rat renal tissue with the above MAb and the APAAP staining technique displayed a heterogenous reginal and subcellular distribution: glomeruli and arterioles were practically devoid of specific staining, as were epithelial cells in inner and outer medulla. Intense immunostaining was observed in PCT and particularly in PST, appearing granular with highest density around the nuclei. Here the enzyme bound to intracellular membranes may exert an autocrine function such as signal inactivation. In contrast to cortex, staining of interstitial cells was observed in renal medulla. The latter localization is compatible with the concept of a paracrine function of 11-HSD which might prevent corticosterone from gaining access to collecting duct cells.

Isoelectric focusing analysis of detergent extracted renal 11 beta-hydroxysteroid dehydrogenase.

11 beta-hydroxysteroid dehydrogenase (11-HSD, EC 1.1.1.146) from rat renal cortex microsomes was solubilized using several detergents, the most effective being Zwittergent 3-10 and Triton X-100. The activity ratio oxidation/reduction of the reversible reaction corticosterone in equilibrium 11-dehydrocoticosterone varied depending on the detergent used. We attribute this variation to direct effects of different detergents on enzyme kinetics. In contrast, comparable results obtained with liver 11-HSD have been attributed to the possibility of spatially separated 11-oxidase and 11-reductase activities. In order to test whether renal 11-HSD represents a uniform oxido-reductase as generally assumed, or a dual enzyme system as has been recently proposed an attempt was made to characterize 11-HSD solubilized from renal microsomal fractions using isoelectric focusing (IEF). When 11-HSD was extracted with 1% Triton X-100 (= partially solubilized fraction) a heterogenous peak pattern was obtained. In contrast, IEF of 11-HSD extracted with 10% Triton X-100 (= delipidated fraction) resulted in a single peak at about pH 5.9 with both oxidative and reductive activity at practically identical positions within the gels. From this observation we conclude that the degree of detergent solubilization of a membrane bound protein affects its amphoteric properties and that removal of membranous lipids is a prerequisite for the analysis of its behaviour. Since the more delipidated fraction of 11-HSD revealed only one activity peak the data are compatible with the uniform enzyme concept since oxidative and reductive activities of renal cortical 11-HSD could not be separated.

Renal epithelial cell lines (BSC-1, MDCK, LLC-PK1) express 11 beta-hydroxysteroid dehydrogenase activity.

Renal tissue of several species has been shown to express considerable 11 beta-hydroxysteroid dehydrogenase (11-HSD, EC 1.1.1.146) activity. However, it is uncertain as to which renal cell types exhibit 11-HSD activity. In the present study, we investigated corticosterone metabolism in BSC-1 cells, a continuous renal epithelial cell line derived from the African green monkey (Cercopithecus aethiops). In incubation experiments using 3H-labelled corticosterone and HPLC, we have demonstrated oxidative 11-HSD activity in intact monolayers of BSC-1 cells as well as in BSC-1 cell homogenates. 11-HSD activity in cell homogenates could be stimulated 7-9-fold by the addition of exogenous NADP+ (1 mM). In contrast, no reductive 11-HSD could be detected either in intact cells or in cell homogenates under various experimental conditions which were designed to favor reductive 11-HSD activity. Pilot experiments were performed in cell homogenates from two other renal epithelial cell lines derived from canine (MDCK) and porcine (LLC-PK1) kidney. They also revealed oxidative but no reductive 11-HSD activity. The data provide evidence for an epithelial localization of renal oxidative 11-HSD activity.

Aldosterone metabolism in rat renal tissue in vitro. Formation of lipid soluble metabolites.

In the present study the formation of lipid soluble metabolites from 3H-aldosterone was investigated in vitro in isolated kidneys and kidney and liver slices of Sprague Dawley rats. The steroids were separated by HPLC (forward and reversed phase systems) and detected on-line as UV- or 3H-chromatograms. Apart from an unenzymatically formed substance, isoaldosterone, three less polar metabolites were traced (A1, A2, A3). The structure of the quantitatively most important metabolite (A1), was identified as 5 alpha-dihydroaldosterone using a combination of techniques such as chromatographic comparison with reference steroids, antibody binding and mass spectrometry. Evidence for further conversion of DHaldo to 3 alpha, 5 alpha-tetrahydroaldosterone was obtained in chromatographic and antibody binding studies. The formation of metabolites was not dependent on glomerular filtration. Furthermore it displayed regional heterogeneity with highest activity in the outer medulla. Finally it was observed that the in vitro metabolism of aldosterone was not saturable over a range of initial aldo concentration of 10(-9) to 10(-5) M.